Basic Information
| Provider Information | |||||||||
| NPI: | 1235876806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRACE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 MADIO DR | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703643827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852327969 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Practice Location | |||||||||
| Address1: | 567 CORPORATE DR | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703602834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852327969 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2022 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | CELESTIN | ||||||||
| AuthorizedOfficialFirstName: | LATOYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 9852327969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 12468 | 01 | LA | COUNSEING | OTHER |